Work

745Risk of Peripheral Blood Eosinophilia and Hypersensitivity Reactions among Patients Receiving Outpatient Parenteral Antibiotics

Year: 2014

Type: article

Abstract: Background. Drug-induced peripheral eosinophilia (EOS) complicates antimicrobial therapy, though little is known about its frequency and implications. Using a population of monitored outpatients on parenteral antibiotics, we aimed to determine the frequency of drug-induced EOS and risk of subsequent hypersensitivity reactions (HSR). Methods. We evaluated a prospective cohort from the Outpatient Parenteral Antimicrobial Therapy program consisting of discharged inpatients evaluated by Infectious Disease consultants beginning therapy from September 1, 2012-December 31, 2013 and monitored during prescribed intravenous antibiotic therapy (>2 weeks) with at least one differential blood count. We considered whether age or gender was associated with EOS, defined as an absolute eosinophil count (AEC) ≥500/mL. We examined the association of EOS with subsequent sign of HSR, including: documented rash; liver injury (new ALT > 100U/L); and renal injury (CrCL increase >0.5mg/dL or 50% of baseline). Relative risk was calculated from binomial regression with a log link accounting for periods before and after onset of EOS, defined as 5 days before EOS detection. Results. Of the 824 patients, 60% were male with median age 60y and median duration of therapy 41d (IQR: 31-45d). Of these, 210 (25%) developed EOS with a median peak AEC of 726/mL (IQR: 594-990/mL, range: 500-8,610/mL). Occurrence of EOS was associated with greater age (median: 64y vs 59y, p<0.001), but not gender (p>0.25). There were subsequent signs of HSR in 65/210 (31%) of patients with EOS, including rash (N = 32), renal injury (N = 31), and liver injury (N = 13). Once patients develop EOS, compared to patients who never develop EOS, they are at increased risk of developing rash (15.2% vs 6.0%, p < 0.001; RR 3.2, 95% CI 2.0,5.0;) and possibly renal injury (14.8% vs 10.1%, p = 0.08; RR 1.8, 95%CI 1.2, 2.7), but not liver injury (6.2% vs 6.7%, p > 0.5; RR 1.05, 95%CI 0.58, 1.9). Conclusion. Eosinophilia is a common complication of extended parenteral antimicrobial therapy. A majority of patients with EOS do not develop signs of an HSR. However, EOS confers an over 3-fold risk of developing a rash and may increase the risk of renal injury. Further studies are needed to examine whether patients with EOS have a greater risk of renal or liver injury. Disclosures. All authors: No reported disclosures.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofu052.453

Authors: Kimberly Blumenthal, Ilan Youngster, Robert Parker, Rochelle Walensky, Sandra Nelson

Institutions: Harvard University, Massachusetts General Hospital, Boston Children's Hospital

Language: English

Topic: Drug-Induced Adverse Reactions

Subfield: Pharmacology (medical)

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $4,053